| NPI | 1801044896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MD 04542) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MD 04542) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 04542) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MD 04542) | |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2018-06-22 |